Cancer After Liver Transplantation in Children and Young Adults: A Population-Based Study From 4 Nordic Countries.

Cancer after liver transplantation (LT) constitutes a threat also for young recipients, but cancer risk factors are usually absent in children and large studies on the cancer risk profile in young LT recipients are scarce. Data of patients younger than 30 years who underwent LT during the period 1982-2013 in the Nordic countries were linked with respective national cancer registries to calculate standardized incidence ratios (SIRs). A total of 37 cancer cases were observed in 923 patients with 7846 person-years of follow-up. The SIR for all cancer types, compared with the matched general population, was 9.8 (12.4 for males and 7.8 for females). Cumulative incidence of cancer adjusted for the competing risk of death was 2% at 10 years, 6% at 20 years, and 22% at 25 years after LT. Non-Hodgkin lymphoma was the most common cancer type (n = 14) followed by colorectal (n = 4) and hepatocellular cancer (n = 4). Age was a significant risk factor for cancer, and the absolute risk of most cancers (except for lymphoma) increased considerably in young adults older than 20 years. The cancer risk pattern is different in pediatric and young LT patients compared with adult recipients. The striking increase in cancer incidence in young adulthood after the second decade of life deserves further consideration in transition programs.

Increased pancreatic cancer risk following radiotherapy for testicular cancer.

BACKGROUND: Pancreatic cancer risk is elevated among testicular cancer (TC) survivors. However, the roles of specific treatments are unclear. METHODS: Among 23 982 5-year TC survivors diagnosed during 1947-1991, doses from radiotherapy to the pancreas were estimated for 80 pancreatic cancer patients and 145 matched controls. Chemotherapy details were recorded. Logistic regression was used to estimate odds ratios (ORs). RESULTS: Cumulative incidence of second primary pancreatic cancer was 1.1% at 30 years after TC diagnosis. Radiotherapy (72 (90%) cases and 115 (80%) controls) was associated with a 2.9-fold (95% confidence interval (CI) 1.0-7.8) increased risk. The OR increased linearly by 0.12 per Gy to the pancreas (P-trend<0.001), with an OR of 4.6 (95% CI 1.9-11.0) for ⩾25 Gy vs <25 Gy. Radiation-related risks remained elevated ⩾20 years after TC diagnosis (P=0.020). The risk increased with the number of cycles of chemotherapy with alkylating or platinum agents (P=0.057), although only one case was exposed to platinum. CONCLUSIONS: A dose-response relationship exists between radiation to the pancreas and subsequent cancer risk, and persists for over 20 years. These excesses, although small, should be considered when radiotherapy with exposure to the pancreas is considered for newly diagnosed patients. Additional data are needed on the role of chemotherapy.

Quality assessment of prostate cancer reports to the Danish Cancer Registry.

BACKGROUND: The Danish Cancer Registry (DCR) is the oldest nationwide population-based cancer registry in the Nordic countries. At the time of the study the DCR recorded date of diagnosis, tumor stage and initial treatment. The validity of the clinical information reported to the DCR has never been analyzed. MATERIAL AND METHODS: Patients diagnosed with prostate cancer from 1 May to 31 December 1997 and living in eight Danish counties were identified through the DCR. Clinical data was retrieved from hospital records where date of diagnosis, stage at diagnosis and treatment received were registered. RESULTS: The mean age at diagnosis was 74.6 years (s.d. 8.6 years). Diagnosis was verified histologically for 87% of cases. Overall 95% of the patients had a difference less than three months between the reported date of diagnosis and the date found in hospital records. Correction of dates of diagnosis had no impact on survival. Hospital records identified 86 patients with T1-2 disease without distant metastases (M0), but only 56 of these patients (65%) were reported to the DCR as having localized disease. According to hospital records a total of 242 patients were confirmed having distant metastases (M1) at diagnosis but only 139 of these cases (57%) were reported to the DCR as such. Considerable "over reporting" of curative treatment was observed. CONCLUSION: The DCR has been shown to be reliable in terms of new cases being reported. For the majority of cases there were insignificant differences concerning the date of diagnosis. However, the DCR information on stage and treatment was found to be inaccurate. Since 2004 the DCR registration process, including staging according to the TNM classification, has been carried out electronically from several registers. Future comparison between cohorts of different time intervals or international comparison should be interpreted with caution when clinical information is included.

Trends in cancer in the elderly population in Denmark, 1980-2012.

BACKGROUND: Age is the strongest risk factor for developing cancer. The aim of the present analysis is to give an overview of the trends in cancer incidence, mortality, prevalence, and relative survival in Denmark from 1980 to 2012 focusing on age, comparing persons aged 70 years or more with those aged less than 70 years. MATERIAL AND METHODS: Data derived from the NORDCAN database with comparable data on cancer incidence, mortality, prevalence and relative survival in the Nordic countries. The Danish data originate from the Danish Cancer Registry and the Danish Cause of Death Registry with follow-up for death or emigration until the end of 2013. RESULTS: Incidence and mortality rates of all sites, but non-melanoma skin cancer, were higher and relative survival was lower among persons aged 70 years or more than those aged less than 70 years. The age distribution (age group-specific percentages of total number of incident cases) remained constant over time while the percentage of persons dying from cancer decreased with time up to the age of 79 years but increased for those aged 80 years or more, in whom about a third of all cancer deaths occurred in 2012. In 2003-2007, the five-year relative survival was 48% for men aged 70-79 years, 38% for men aged 80-89 years, and 29% for men aged 90 years or more and the corresponding figures for women were 46%, 39%, and 36%, respectively. There was a substantial increase in the number of prevalent cancer cases aged 70 years or older, especially among those aged 90 years or more. CONCLUSION: An increase in elderly cancer patients is expected over the coming 20 years due to an increasing elderly population. Healthcare providers need to focus on developing specific strategies for treatment of elderly cancer patients in the future.

Mortality from cancer and other causes in commercial airline crews: a joint analysis of cohorts from 10 countries.

BACKGROUND: Commercial airline crew is one of the occupational groups with the highest exposures to ionising radiation. Crew members are also exposed to other physical risk factors and subject to potential disruption of circadian rhythms. METHODS: This study analyses mortality in a pooled cohort of 93 771 crew members from 10 countries. The cohort was followed for a mean of 21.7 years (2.0 million person-years), during which 5508 deaths occurred. RESULTS: The overall mortality was strongly reduced in male cockpit (SMR 0.56) and female cabin crews (SMR 0.73). The mortality from radiation-related cancers was also reduced in male cockpit crew (SMR 0.73), but not in female or male cabin crews (SMR 1.01 and 1.00, respectively). The mortality from female breast cancer (SMR 1.06), leukaemia and brain cancer was similar to that of the general population. The mortality from malignant melanoma was elevated, and significantly so in male cockpit crew (SMR 1.57). The mortality from cardiovascular diseases was strongly reduced (SMR 0.46). On the other hand, the mortality from aircraft accidents was exceedingly high (SMR 33.9), as was that from AIDS in male cabin crew (SMR 14.0). CONCLUSIONS: This large study with highly complete follow-up shows a reduced overall mortality in male cockpit and female cabin crews, an increased mortality of aircraft accidents and an increased mortality in malignant skin melanoma in cockpit crew. Further analysis after longer follow-up is recommended.

Colorectal Cancer Survival in German-Danish Border Regions-A Registry-Based Cohort Study.

The aim of this study was (i) to update the reporting of colorectal cancer survival differences over time in the German-Danish border region (Schleswig-Holstein, Southern Denmark, and Zealand) and (ii) to assess the extent to which it can be explained by stage and primary treatment. Incident invasive colorectal cancer cases diagnosed from 2004 to 2016 with a follow-up of vital status through 31 December 2017 were extracted from cancer registries. Analyses were conducted by anatomical subsite and for four consecutive periods. Kaplan-Meier curves and log-rank tests were computed. Cox regression models using data from Schleswig-Holstein from 2004 to 2007 as the reference category were run while controlling for age, sex, stage, and treatment. The cox regression models showed decreasing hazard ratios of death for all three regions over time for both anatomical subsites. The improvement was stronger in the Danish regions, and adjustment for age, sex, stage, and treatment attenuated the results only slightly. In 2014-2016, colon cancer survival was similar across regions, while rectal cancer survival was significantly superior in the Danish regions. Regional survival differences can only partially be explained by differing stage distribution and treatment and may be linked additionally to healthcare system reforms and screening efforts.

Nordcan.R: a new tool for federated analysis and quality assurance of cancer registry data.

Aim of the article: We present our new GDPR-compliant federated analysis programme (nordcan.R), how it is used to compute statistics for the Nordic cancer statistics web platform NORDCAN, and demonstrate that it works also with non-Nordic data. Materials and methods: We chose R and Stata programming languages for writing nordcan.R. Additionally, the internationally used CRG Tools programme by International Agency for Research on Cancer (IARC/WHO) was employed. A formal assessment of (GDPR-compliant) anonymity of all nordcan.R outputs was performed. In order to demonstrate that nordcan.R also works with non-Nordic data, we used data from the Netherlands Cancer Registry. Results: nordcan.R, publicly available on Github, takes as input cancer and general population data and produces tables of statistics. Each NORDCAN participant runs nordcan.R locally and delivers its results to IARC for publication. According to our anonymity assessment the data can be shared with international organizations, including IARC. nordcan.R incidence results on Norwegian and Dutch data are highly similar to those produced by two other independent methods. Conclusion: nordcan.R produces accurate cancer statistics where all personal and sensitive data are kept within each cancer registry. In the age of strict data protection policies, we have shown that international collaboration in cancer registry research and statistics reporting is achievable with the federated analysis approach. Undertakings similar to NORDCAN should consider using nordcan.R.

Survival of breast cancer patients in German-Danish border regions - A registry-based cohort study.

BACKGROUND AND AIM: Denmark reports slightly lower breast cancer survival before 2010 than its neighbouring country Germany. Previous research is limited by lacking stage and treatment information. This study aims to investigate differences in breast cancer survival between the bordering regions Schleswig-Holstein (Germany), Southern Denmark and Zealand (Denmark) using registry data including stage and treatment information. METHOD: Invasive female breast cancer cases diagnosed during 2004-2013 with follow up through 31st December 2014 were extracted from cancer registries. Cases notified by death certificates only and those aged 90+ years were excluded. Kaplan-Meier curves and log-rank tests were computed. Cox regression analysis was conducted with adjustment for year of diagnosis, age, stage, and treatment. RESULTS: The analytical sample included 42,966 cases. Kaplan-Meier curves and log-rank tests show significant survival differences between the regions. The Cox regression model adjusted for year of diagnosis and age shows significantly worse overall survival of breast cancer patients in both Danish regions compared to Schleswig-Holstein with hazard ratios (HR) of 1.09 (95 % CI: 1.04; 1.15) for patients from Southern Denmark (SD) and 1.25 (95 % CI: 1.18; 1.32) for residents of Zealand (ZL). This effect diminished after adjustment for stage and treatment (HR: 1.05 (SD), 1.09 (ZL) 95 % CI: 0.99; 1.10 (SD), 1.03; 1.15 (ZL)). CONCLUSION: Survival differences can be explained by differing stage distribution and treatment administration, which formerly were more favourable in Schleswig-Holstein. The survival gap will probably close due to Denmark's national screening program and increased use of adjuvant cancer therapy.

The histology of brain tumors for 67 331 children and 671 085 adults diagnosed in 60 countries during 2000-2014: a global, population-based study (CONCORD-3).

BACKGROUND: Global variations in survival for brain tumors are very wide when all histological types are considered together. Appraisal of international differences should be informed by the distribution of histology, but little is known beyond Europe and North America. METHODS: The source for the analysis was the CONCORD database, a program of global surveillance of cancer survival trends, which includes the tumor records of individual patients from more than 300 population-based cancer registries. We considered all patients aged 0-99 years who were diagnosed with a primary brain tumor during 2000-2014, whether malignant or nonmalignant. We presented the histology distribution of these tumors, for patients diagnosed during 2000-2004, 2005-2009, and 2010-2014. RESULTS: Records were submitted from 60 countries on 5 continents, 67 331 for children and 671 085 for adults. After exclusion of irrelevant morphology codes, the final study population comprised 60 783 children and 602 112 adults. Only 59 of 60 countries covered in CONCORD-3 were included because none of the Mexican records were eligible. We defined 12 histology groups for children, and 11 for adults. In children (0-14 years), the proportion of low-grade astrocytomas ranged between 6% and 50%. Medulloblastoma was the most common subtype in countries where low-grade astrocytoma was less commonly reported. In adults (15-99 years), the proportion of glioblastomas varied between 9% and 69%. International comparisons were made difficult by wide differences in the proportion of tumors with unspecified histology, which accounted for up to 52% of diagnoses in children and up to 65% in adults. CONCLUSIONS: To our knowledge, this is the first account of the global histology distribution of brain tumors, in children and adults. Our findings provide insights into the practices and the quality of cancer registration worldwide.

Trends in the survival of patients diagnosed with breast cancer in the Nordic countries 1964-2003 followed up to the end of 2006.

BACKGROUND: Breast cancer is the leading cancer among women worldwide in terms of both incidence and mortality. European patients have generally high 5-year relative survival ratios, and the Nordic countries, except for Denmark, have ratios among the highest. MATERIAL AND METHODS: Based on the NORDCAN database we present trends in age-standardised incidence and mortality rates of invasive breast cancer in the Nordic countries, alongside 5- and 10-year relative survival for the period of diagnosis 1964-2003 followed up to the end of 2006. Excess mortality rates are also provided for varying follow-up intervals after diagnosis. The analysis is confined to invasive breast cancer in Nordic women. RESULTS: Incidence increased rapidly in all five countries, whereas mortality remained almost unchanged. Both incidence and mortality rates were highest in Denmark. Between 1964 and 2003 both 5- and 10-year relative survival increased by 20-30 percentage points in all countries, and 10-year survival remained around 10 percentage points lower than 5-year survival. Relative survival was lowest in Denmark throughout the period, with a 5-year survival of 79% for years 1999-2003, but 83-87% in the other countries. From 1964 the youngest women had the highest survival ratios up until the introduction of screening, when a shift occurred towards higher survival among age groups 50-59 and 60-69 in each country, except for Denmark. Excess death rates during the first months after diagnosis were highest in Denmark. CONCLUSION: Breast cancer survival is high and rising in the Nordic countries, and probably relates to the early implementation of organised mammography screening in each country except Denmark and a high and relatively uniform standard of living, diagnosis and treatment. Denmark stands out with higher mortality and poorer survival. The major determinants may include a failure to instigate national breast screening and a greater co-morbidity resulting from a higher prevalence of both tobacco smoking and alcohol consumption.

Survival of patients diagnosed with cancer in the Nordic countries up to 1999-2003 followed to the end of 2006. A critical overview of the results.

UNLABELLED: Differences in Nordic cancer patient survival observed today originate from the 1970s, but were first identified in a mortality prediction from 1995. This paper provides timely comparisons of survival using NORDCAN, a database with comparable information from the Nordic cancer registries. Elucidation of the differences is important when monitoring cancer care generally and evaluating the impact of cancer plans. MATERIAL AND METHODS: The NORDCAN database 1964-2003 with follow-up for death through 2006, was used to analyse incidence, mortality, and survival for all NORDCAN cancer sites. We analysed 5-year relative survival and excess mortality rates in the first three months and 2-5 years after diagnosis. RESULTS: The time trends in survival 1989-2003 were largely similar between the Nordic countries with increases in 14 sites among men and 16 among women. In all countries the excess mortality rates were highest in the first three months after diagnosis, but decreased to similar levels across all countries 2-5 years after diagnosis. Comparing countries excess mortality was highest in Denmark irrespective of follow-up period. Lower survival was observed for Danish cancer patients in 23 of the 33 cancer sites in men and 26 of 35 sites in women. Low and similar levels of survival were observed for cancers of the oesophagus, lung, liver and pancreas, while an 8-10 percentage point difference in survival was found between countries for colorectal cancer. CONCLUSION: The notable differences in Nordic cancer patient survival can be linked to national variations in risk factors, co-morbidity, and the implementation of screening. Improved treatment and primary prevention, in particular the targeting of tobacco and alcohol use, is required to improve cancer control. The recently-initiated cancer plans in Denmark and Norway are yet to show an observable effect on the corresponding cancer survival.

Trends in survival of patients diagnosed with cancer of the digestive organs in the Nordic countries 1964-2003 followed up to the end of 2006.

UNLABELLED: Cancers of the digestive organs (including the oesophagus, stomach, small intestine, colon, rectum and anus, liver, gallbladder, and pancreas) constitute one-fifth of all cancer cases in the Nordic countries and is a group of diseases with diverse time trends and varying consequences for public health. In this study we examine trends in relative survival in relation to the corresponding incidence and mortality rates in the Nordic countries during the period 1964-2003. MATERIAL AND METHODS: Data were retrieved from the NORDCAN database for the period 1964 to 2003, grouped into eight 5-year periods of diagnosis. The patients were followed up until the end of 2006. Analysis comprised trends in 5-year relative survival, excess mortality and age-specific relative survival. RESULTS: Survival following cancers of the colon and rectum has increased continuously over the observed period, yet Danish patients fall behind those in the other Nordic countries. The largest inter-country variation is seen for the rare cancers in the small intestine. There has been little increase in prognosis for patients diagnosed with cancers of the liver, gallbladder or pancreas; 5-year survival is generally below 15%. Survival also remains consistently low for patients with oesophageal cancer, while minor increases in survival are seen among stomach cancer patients in all countries except Denmark. The concomitant incidence and mortality rates of stomach cancer have steadily decreased in each Nordic country at least since 1964. CONCLUSION: While the site-specific variations in mortality and survival largely reflect the extent of changing and improving diagnostic and clinical practices, the incidence trends highlight the importance of risk factor modification. Alongside the ongoing clinical advances, effective primary prevention measures, including the control of alcohol and tobacco consumption as well as changing dietary pattern, will reduce the incidence and mortality burden of digestive cancers in the Nordic countries.

Trends in the survival of patients diagnosed with malignant melanoma of the skin in the Nordic countries 1964-2003 followed up to the end of 2006.

UNLABELLED: A previous Nordic study showed a marked and steady increase in the age-adjusted 5-year relative survival of skin melanoma patients diagnosed during the period 1958 through 1987. Males had considerably poorer survival than females. MATERIAL AND METHODS: Using the NORDCAN database, we studied relative survival and excess mortality of patients diagnosed with melanoma of the skin in the Nordic countries 1964-2003 followed up to the end of 2006. These were contrasted with concomitant trends in incidence and mortality. RESULTS: The overall incidence of melanoma almost quadrupled, but there was considerable variation in the trends in the five countries. Mortality was low but doubled during the study period. Survival ratios increased steadily to between 80% and 90% for patients diagnosed in 1999-2003. Swedish patients had consistently higher survival, whereas Danish patients had the highest excess death rates the first three months after diagnosis up until 1990, but thereafter, rates reached a similar low level to that observed in the other Nordic countries. The survival of Nordic women is still higher than that of men, but the difference has diminished, while the mortality rates among men are becoming increasingly higher relative to those for women among individuals 50 years and older. In younger individuals, mortality rates are similar in the two sexes, and declining. CONCLUSIONS: Nordic patient survival following melanoma diagnosis is generally high and has been steadily increasing in the last decades. Differences in incidence between the five countries are more pronounced than the differences in survival. The strong upward trends in incidence and survival may mainly be the result of extensive changes in sunbathing habits or other UV exposure and, more recently, of an increasing awareness by the medical community and the public concerning early detection of melanoma of the skin.

Trends in the survival of patients diagnosed with malignant neoplasms of lymphoid, haematopoietic, and related tissue in the Nordic countries 1964-2003 followed up to the end of 2006.

BACKGROUND: Hodgkin lymphoma, Non-Hodgkin lymphoma, multiple myeloma, and acute and other leukaemias constitute about 7% of the overall cancer incidence and 8% of cancer mortality in the Nordic countries. The aim of this study is to describe and interpret the trends in relative survival and excess mortality in the five Nordic populations among these patients. MATERIAL AND METHODS: Using the NORDCAN database 1964-2003, we estimated age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods, and age-specific 5-year relative survival by country, sex, and 5-year diagnostic period. RESULTS: Taking into account classification and registration problems in the earlier periods, the patterns of incidence, mortality, and survival are fairly similar between the countries within each cancer form studied. High 5-year relative survival ratios of over 80% were seen in the most recent period 1999-2003 for Hodgkin lymphoma, between 50 and 60% for Non-Hodgkin lymphoma, 38-49% for acute leukaemia and 60-73% for other leukaemia. The variations were between 28 and 41% for multiple myeloma. Danish patients diagnosed with these malignancies tend to fare slightly worse than their Nordic neighbours, with excess mortality rates marginally higher one to three months after diagnosis. CONCLUSION: Although the recent trends and absolute levels of incidence, mortality and survival for the lympho-haematopoietic malignancies are similar, the consistently lower survival of Danish patients--irrespective of type of malignancy--points to an impact of co-morbidity related lifestyle factors, which may negatively affect the chemotherapy and radiation offered as standard treatments for these diseases.

Trends in the overall survival of cancer patients diagnosed 1964-2003 in the Nordic countries followed up to the end of 2006: the importance of case-mix.

AIM: Overall survival after cancer is frequently used when assessing the health care service performance as a whole. While used by the public, politicians, and the media, it is often discarded by clinicians and epidemiologists due to the heterogeneous mix of different cancers, risk factors and treatment modalities. We studied the trend in the Nordic 5-year relative survival and excess mortality for all cancers combined to see if the impact of case-mix and variations between countries in diagnostic methods such as breast screening and PSA testing could explain the lower survival in Denmark. MATERIAL AND METHODS: From the NORDCAN database 1964-2003, we defined two cohorts of cancer patients, one excluding non-melanoma skin cancer and another also excluding breast and prostate cancer. We estimated age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods, and age-specific 5-year relative survival by country, sex and 5-year diagnostic period. RESULTS: Prostate cancer is the main driver of the incidence increase in men, as do breast cancer in women, whereas cancer mortality in all Nordic countries is declining. The 5-year relative survival ratios are increasing in each Nordic population, but less so in Denmark. Country differences in survival stem mainly from follow-up periods immediately after diagnosis. Adjusting for the case-mix of diagnoses diminished differences a little while exclusion of breast and prostate cancer reduced the gap between countries in survival and excess mortality more considerably, yet post-adjustment, Danish patients still fare worse during the first three months after diagnosis. CONCLUSION: Adjustment for case-mix and exclusion of sites where diagnostic procedures change the pattern of incidence is important when comparing overall cancer survival across countries, but the correction only explains part of the observed differences in survival. Other factors such as stage at presentation, co-morbidity, tobacco and alcohol consumption are likely contributors.

Trends in survival of patients diagnosed with cancers of the brain and nervous system, thyroid, eye, bone, and soft tissues in the Nordic countries 1964-2003 followed up until the end of 2006.

BACKGROUND: Diagnoses of cancer of the brain, thyroid, eye, bone, and soft tissues are categorised by heterogeneity in disease frequency, survival, aetiology and prospects for curative therapy. In this paper, temporal trends in patient survival in the Nordic countries are considered. MATERIAL AND METHODS: Age-standardised incidence and mortality rates, 5-year relative survival, and excess mortality rates for varying follow-up periods are presented, as are age-specific 5-year relative survival by country, sex and 5-year diagnostic period. RESULTS: Brain cancer incidence rates have been rising but mortality has been relatively stable, with 5-year survival uniformly increasing from the early-1970s, particularly in younger patients. Five-year survival from brain cancer among men varies between 45% and 50% for men and 60% to 70% in women, with excess deaths decreasing with time in each of the Nordic populations. Age-standardised incidence rates of thyroid cancer have been mainly increasing during the 1960s and 1970s, although trends thereafter diverge, with 5-year relative survival increasing 20-30 percentage points over the last 40 years to around 80-90%. Thyroid cancer survival is consistently lower in Denmark, particularly in patients diagnosed aged over 60, while there is less geographic variation in excess deaths three months beyond initial diagnosis. Relative survival from eye cancer increased with time from approximately 60% in 1964-1968 to 80% 1999-2003, while for bone sarcoma, incidence rates remained stable, mortality rates declined, and 5-year survival increased slightly to around 55-65%. Soft tissue sarcoma incidence and survival have been slowly increasing since the 1960s, with little variation in survival (around 65%) for the most recent period. CONCLUSIONS: There have been some notable changes in survival that can be linked to epidemiological and clinical factors in different countries over time. Time-varying proportions of the major histological subtypes might however have affected the survival estimates for a number of the cancer forms reviewed here.

Trends in the survival of patients diagnosed with cancer in female genital organs in the Nordic countries 1964-2003 followed up to the end of 2006.

UNLABELLED: Cancers of the female genital organs constitute more than 12% of all female cancers in the Nordic countries. The group includes cervix uteri, corpus uteri, ovary and other female genital organs including vulva and vagina, and in this study we compare the development in the Nordic countries regarding incidence, mortality and relative survival. MATERIAL AND METHODS: Data were retrieved from the NORDCAN database for the period 1964 to 2003, grouped into eight 5-year periods. The patients were followed up until the end of 2006. Analyses comprised trends in 5-year relative survival, excess mortality and age-specific relative survival. RESULTS: A substantial reduction of cervical cancer incidence followed the introduction of population-based screening in the 1970s and was also accompanied by a modest improvement in survival. Incidence trends in cancer of corpus uteri varied between the countries but the survival increased by around 20 percentage points during the study period in all countries. Ovarian cancer patients have the lowest survival among female genital cancers, but survival increased 10-15 percentage points over the 40 years of observation, while the incidence and mortality were rather stable throughout the observed period. Cancers of the other female genital organs, including vulva and vagina, are rare diagnoses and only small changes in incidence, mortality and survival have been observed over time. CONCLUSION: The declining trends in cervical cancer incidence and mortality, and improving survival of corpus uteri cancer patients, are in contrast with the rather poor prognosis associated with an ovarian cancer diagnosis. Cancer-specific differences between countries in the survival of female patients diagnosed with cancers of the cervix uteri, corpus uteri and other female genital organs are small.